Ross procedure for ascending aortic replacement

Background. Patients with aortic valve disease and aneurysm or dilatation o f the ascending aorta require both aortic valve replacement and treatment o f their ascending aortic disease. In children and young adults, the Ross op eration is preferred when the aortic valve requires replacement, but the ef ficacy of extending this operation to include replacement of the ascending aorta or reduction of the dilated aorta has not been tested. Methods. We reviewed the medical records of 18 (5.9%) patients with aortic valve disease and an ascending aortic aneurysm and 26 (8.5%) patients with dilation of the ascending aorta, subgroups of 307 patients who had a Ross o peration between August 1986 and February 1998. We examined operative and m idterm results, including recent echocardiographic assessment of autograft valve function and ability of the autograft root and ascending aortic repai r or replacement to maintain normal structural integrity. Results. There was one operative death (2%) related to a perioperative stro ke. Forty-two of 43 survivors have normal autograft valve function, with tr ace to mild autograft valve insufficiency, and one patient has moderate ins ufficiency at the most recent echocardiographic evaluation. None of the pat ients has dilatation of the autograft root or of the replaced or reduced as cending aorta. Conclusions. Early results with extension of the Ross operation to include replacement of an ascending aortic aneurysm or vertical aortoplasty for red uction of a dilated ascending aorta are excellent, with autograft valve fun ction equal to that seen in similar patients without ascending aortic disea se. (C) 1999 by The Society of Thoracic Surgeons.